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HARNETT COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH
307 CORNELIUS HARNETT BOULEVARD
LILLINGTON, NC 27546
EXIS'T'ING SEP'T'IC SYSTEM INSPECTION
NAME PHONE # ✓~/~-95 7~-~5~ 'Z
ADDRESS Ic ve Cf,
NAME OF MOBILE HOME PARK OR S/D jZ- 6 6 ; Fz,0 (_,t-y-- ~
NAME OF OWNER (IFDIFFEREN7)
ADDRESS OF OWNER (IF DIFFERENT)
PROPERTY LOCATION: STATE ROAD NAME AND Z0(02 C ~ C
The aforementioned site'has been e'a Aed byAL6-Harnefftomy ReaTth department
EnvironmentaF Health Section At the time of inspection, there appeared to be aseptic i~
system setvina this 'Site.,, If this,system should malfunction, the owner is responsible f6v~,
a r
THIS INSPECTION IS VOID IF:
(1) the intended use of the septic system should change, and/or
(2) the system should fail or malfunction, and/or
(3) the owner or tenant of the property changes, and/or
(4) after six months
'BUILDING MUST BE 5r FROM ANY PART OF. SEPTIC. SYSTEM
,
DO' NODRIVE 0Y+'~,. +n Y PARS Old SEPTICSYSTEN
3„ t a.w w f a `.y t~
AUTHORIZATION OF EXISTING SYSTEM
of Environmental Health Specialist Date